This publication presents mental health information collected in the National Health Survey (NHS) which was conducted by the Australian Bureau of Statistics (ABS) from February to November 2001 (see Explanatory Notes). The survey was designed to obtain national benchmarks on a wide range of health issues, and to enable the monitoring of changes in health over time.

Information was collected on mental health through questions covering:

The two main measures analysed in this publication are long-term mental and behavioural problems, and psychological distress as measured by the K10. Additional information from the other three measures is also included where possible.

Mental and behavioural problems were identified through the self-reported information on long-term conditions obtained by the survey. However, unlike for other National Health Priority Area (NHPA) conditions such as cancer, cardiovascular conditions, diabetes and asthma, respondents in the survey were not specifically asked whether they had been diagnosed with any mental disorders. Therefore the information provided by respondents may have been based on self-diagnosis rather than diagnosis by a health professional. The proportions of the population with specific mental and behavioural problems are also small. Analysis in this publication is therefore confined to the broader level of mental health conditions.

Inquiries

For further information about these and related statistics, contact the National Information and Referral Service on 1300 135 070.

SUMMARY OF FINDINGS

PREVALENCE

Sex and age: people with long-term mental and behavioural problems

Most people in Australia enjoy good mental health. However, in 2001, approximately 1.8 million people (9.6% of the population) reported having a long-term mental or behavioural problem that had lasted, or was expected to last, for six months or more. Females were more likely than males to report having a mental or behavioural problem (10.6% of females and 8.5% of males).

In 2001, the most commonly reported mental and behavioural problems were mood (affective) problems and anxiety related problems. Each of these were reported by 4.5% of people.

Persons: mental and behavioural problems(a)

Males

Females

Persons

'000

%

'000

%

'000

%

Type of mental and behavioural problem

Organic mental problems

*8.3

*0.1

*13.3

*0.1

21.6

0.1

Alcohol and drug problems

78.9

0.8

51.8

0.5

130.6

0.7

Mood (affective) problems

320.3

3.4

528.6

5.5

848.9

4.5

Anxiety related problems

317.4

3.4

535.9

5.6

853.3

4.5

Problems of psychological development

142.6

1.5

92.8

1.0

235.4

1.2

Behavioural and emotional problems with usual onset in childhood/adolescence

108.1

1.2

38.7

0.4

146.8

0.8

Other mental and behavioural problems

56.7

0.6

28.4

0.3

85.1

0.4

Symptoms and signs involving cognition, perceptions, emotional state and behaviour

75.4

0.8

78.6

0.8

154.0

0.8

Total with mental and behavioural problems(b)

796.4

8.5

1,016.2

10.6

1,812.6

9.6

Total without mental and behavioural problems

8,568.5

91.5

8,535.1

89.4

17,103.7

90.4

Total

9,364.9

100.0

9,551.4

100.0

18,916.3

100.0

* estimate is subject to sampling variability too high for most practical purposes

(a) Mental and behavioural problems which have lasted or are expected to last for six months or more.

(b) Persons may have reported more than one mental and behavioural problem and therefore components may not add to totals.

Mental and behavioural problems overall were more prevalent in adults aged between 18 and 64 years. With the exception of those aged 0-17 years, females recorded the highest rate of mental and behavioural problems overall in each age group. The largest difference between men and women was between those aged 18-24 years (14.1% of women and 7.9% of men).

Certain mental and behavioural conditions were more prevalent among particular age groups. Problems of psychological development (2.7%) and emotional and behavioural problems with usual onset in childhood/adolescence (2.8%), were most prevalent among those aged 0-17 years. Organic mental health problems (including etiology in cerebral disease, brain injury or other insult leading to cerebral dysfunction and dementia) were most prevalent among those aged 75 years and over (1.2%).

People with mental and behavioural problems(a), By sex

Sex and age by level of psychological distress

The Kessler Psychological Distress Scale-10 (K10) is a measure of non-specific psychological distress. A very high level of psychological distress, as shown by the K10, may indicate a need for professional help. In the 2001 NHS, the K10 questions were asked of adults aged 18 years and over.

In 2001, 3.6% of the adult population reported a very high level of psychological distress as measured by the K10. Proportionally more women than men reported a high (10.9% of women and 7.2% of men) and a very high (4.4% of women and 2.7% of men) level of psychological distress.

Level of psychological distress(a)—Persons aged 18 years and over

Low (10-15)

Moderate (16-21)

High (22-29)

Very high (30-50)

Total

'000

%

'000

%

'000

%

'000

%

'000

%

Males

4,780.1

68.8

1,479.0

21.3

498.2

7.2

189.1

2.7

6,946.4

100.0

Females

4,346.3

60.0

1,786.9

24.7

785.5

10.9

319.5

4.4

7,238.3

100.0

Persons

9,126.4

64.3

3,265.9

23.0

1,283.7

9.0

508.7

3.6

14,184.7

100.0

(a) As measured by the Kessler 10 Scale. See Glossary.

A very high level of psychological distress was most frequently recorded for persons aged 45-54 years (5.5% of women and 3.7% of men). Women recorded higher rates than men in all except the 55-64 years age group, where equal proportions of men and women reported a very high level of psychological distress (3.6%). The greatest difference between the sexes was for people aged 18-24 years, with 5.4% of women having a very high level of psychological distress compared with 2.7% of men in the same age group.

People with Very High Level of Psychological Distress(a), By sex

Role limitations due to emotional problems

Of those adults with mental and behavioural problems, half (50%) reported having accomplished less than desired in the four weeks prior to interview, compared with 11% of those without mental and behavioural problems. Of those adults with mental and behavioural problems, 41% reported having worked or performed other regular activities less carefully than usual, compared with 8% of those without mental and behavioural problems.

Consistent with this, a greater proportion of adults with a very high level of psychological distress (78%) reported that they accomplished less than desired in the past four weeks compared with those with low levels of psychological distress (3%). Of those with a very high level of psychological distress, 65% reported having worked or performed other regular activities less carefully than usual compared with 2% of people with low levels of psychological distress.

Quality of life measure

Adults with mental and behavioural problems were most likely to have mixed feelings (34%) or to be feeling mostly satisfied (25%) with life. Those without mental and behavioural problems were most likely to feel mostly satisfied (34%) or pleased (32%) with life. Comparing those with and without mental and behavioural problems, proportionally more people with these problems described their satisfaction with life as mixed, mostly dissatisfied, unhappy or terrible. In contrast, proportionally more people without these problems indicated that they were mostly satisfied, pleased or delighted (graph 3).

People with mental and behavioural problems were five times more likely than those without these problems to describe their satisfaction with life as terrible (4.9% compared with 0.9% without mental and behavioural problems) or unhappy (7.5% compared with 1.4%) and four and a half times more likely to indicate that they were mostly dissatisfied with life (8.5% compared with 1.9%).

Quality of life, Persons aged 18 years and over

Adults who had a very high level of psychological distress were most likely to report feeling mixed (36%), unhappy (18%) and terrible (15%) about their life as a whole. Those with a low level of psychological distress were more likely to report feeling pleased (37%), mostly satisfied (34%) and delighted (15%) with life (graph 4).

QUALITY OF LIFE, Persons aged 18 years and over

SOCIAL CONDITIONS

Place of birth & language spoken at home

The prevalence of mental and behavioural problems among those born in Australia (9.8%) was similar to the rate for people who were born overseas (9.0%). Adults who spoke English at home had a higher rate of mental and behavioural problems (10.6%) than did those who spoke a language other than English at home (9.6%). The opposite was the case for those with a very high level of psychological distress. Those who spoke a language other than English at home had a higher prevalence of a very high level of psychological distress (5.5%) compared with those who spoke English at home (3.2%).

Marital status

After age standardisation, mental and behavioural problems were most prevalent among those who were separated (14% of men and 20% of women) or divorced (13% of men and 18% of women). The rates of mental and behavioural problems for men and women who had never married were higher than for those who were married. The lowest prevalence of mental and behavioural problems was among married men and women (7% of men and 10% of women).

Prevalence of mental and behavioural problems(a), By marital status—Persons aged 18 years and over

Prevalence rate

Age standardised rate(b)

Males

Females

Persons

Males

Females

Persons

%

%

%

%

%

%

Separated

13.8

20.6

17.7

13.7

19.9

17.3

Divorced

12.9

18.1

16.0

12.8

17.8

15.8

Never married

10.8

15.0

12.6

10.2

14.2

12.0

Widowed

9.5

9.4

9.4

12.4

12.8

13.0

Married

6.9

10.1

8.5

7.0

10.0

8.5

Total

8.7

12.2

10.5

8.6

12.2

10.5

(a) Mental and behavioural problems which have lasted or are expected to last for six months or more.

(b) Indirect standardisation.

The prevalence of a very high level of psychological distress was also highest among separated and divorced men and women. Women who were never married also had a high prevalence of a very high level of psychological distress. The lowest rates of a very high level of psychological distress were among married men and women.

Prevalence of very high level of psychological distress(a), By marital status—Persons aged 18 years and over

Prevalence rate

Age standardised rate(b)

Males

Females

Persons

Males

Females

Persons

%

%

%

%

%

%

Separated

*4.0

9.1

7.0

*4.0

9.0

6.9

Divorced

5.5

7.7

6.8

5.4

7.4

6.6

Never married

3.4

5.5

4.3

3.3

5.2

4.1

Widowed

*2.7

3.3

3.1

*3.3

4.2

4.0

Married

2.1

3.4

2.7

2.1

3.4

2.7

Total

2.7

4.4

3.6

2.7

4.4

3.6

* estimate is subject to sampling variability too high for most practical purposes

(a) As measured by the Kessler 10 Scale. See Glossary.

(b) Indirect standardisation.

Living arrangements

Two of the possible ways of examining living arrangements are by the number of people living in a household and the relationship of people living in a household.

First, considering the number of people living in a household, after adjusting for age the rates of mental and behavioural problems and a very high level of psychological distress were highest among adults who lived alone compared with those living in a household with at least one other person. For those people living alone, the rate of mental and behavioural problems was 13.3% compared with 9.8% for people living in a household with three or more people. This difference was greater for men, 13.0% of men living alone had a mental and behavioural problem compared with 8.0% of men who lived in a household with three or more people. Overall the prevalence rates for mental and behavioural problems declined as the number of people living in the household increased. Similarly the rate of very high level of psychological distress was highest among people living alone (4.8%) compared with people living in a household with three or more people (3.4%).

Second, considering the relationship of people living in a household, mental and behavioural problems were most prevalent among those people in one-parent families. The rates were high regardless of whether they were in one-parent families with dependent children (14.8%) or non-dependent children (15.2%). Those people who were living alone (13.3%) had a higher prevalence of mental and behavioural problems than those people in couples only families without children or in couple families with children. Couple families with dependent children (7.3%) and couple families without children (8.7%) had the lowest rate of prevalence of mental and behavioural problems.

Prevalence of mental and behavioural problems(a), By selected Family Type—All ages

Consistent with this, the prevalence of a very high level of psychological distress was highest for adults in one-parent families with dependent children (7.2%) and non-dependent children (6.2%). The lowest prevalence rates were among couple families with dependent children (2.8%) and couples without children (2.8%). Adults living in couple only families or in couple families with dependent children had a lower rate (2.8%) of a very high level of psychological distress compared with persons living alone (4.8%).

Very high level of psychological distress(a), By selected Family Type—Persons aged 18 years and over

Highest level of education

The prevalence of mental and behavioural problems was higher among people without any post-school qualifications (11.2%) than among those with these qualifications (9.3%). This difference was more pronounced for men, 10.0% of those males without post school qualifications had a mental and behavioural problem compared with 7.4% of those with post-school qualifications. A similar trend can be seen with a very high level of psychological distress. Those people who did not have post school qualifications had a higher rate of a very high level of psychological distress (4.7%) compared with those with post-school qualifications (2.4%).

Mental and behavioural problems, and very high level of psychological distress(a)(b), By post-school qualification(c)

With mental and behavioural problems(a)

With a very high level of psychological distress (30-50)(b)

Whether have post school qualification

'000

%

'000

%

Post-school qualification

652.0

9.3

171.3

2.4

No post-school qualification

760.0

11.2

316.2

4.7

Level not stated

71.6

19.3

21.1

5.7

Total

1,483.6

10.5

508.7

3.6

(a) Mental and behavioural problems which have lasted or are expected to last for six months or more.

(b) As measured by the Kessler 10 Scale. See Glossary.

(c) For persons aged 18 years and over.

Labour force status

Labour force status information was collected for persons aged 15 years and over. Respondents were classified as either employed, unemployed, or not in the labour force. After age standardisation, the rates of mental and behavioural problems were highest for males and females who were unemployed (11.3% of males and 19.5% of females) and those who were not in the labour force (15.6% of males and 14.0% of females).

Mental and behavioural problems(a), By labour force status—Persons aged 15 years and over

Prevalence rate

Age standardised rate(b)

Males

Females

Persons

Males

Females

Persons

%

%

%

%

%

%

Employed

7.0

11.0

8.8

6.6

10.6

8.4

Unemployed

11.8

18.4

14.5

11.3

19.5

14.7

Not in the labour force

12.8

12.6

12.7

15.6

14.0

14.5

Total

8.7

12.0

10.4

8.6

12.2

10.5

(a) Mental and behavioural problems which have lasted or are expected to last for six months or more.

(b) Indirect standardisation.

Similarly, after age standardisation, rates for very high level of psychological distress were highest among adults who were unemployed (9.8%) and those not in the labour force (6.4%). For people who were unemployed, the prevalence of a very high level of psychological distress was more than two times the average (3.6%). In contrast, the rate for employed people (1.9%) was substantially lower than the average rate.

Very high level of psychological distress(a), By labour force status—Persons aged 18 years and over

Prevalence rate

Age standardised rate(b)

Males

Females

Persons

Males

Females

Persons

%

%

%

%

%

%

Employed

1.2

3.1

2.1

1.2

2.9

1.9

Unemployed

7.6

14.2

10.3

7.1

13.6

9.8

Not in labour force

6.2

5.4

5.7

7.1

6.0

6.4

Total

2.7

4.4

3.6

2.7

4.4

3.6

(a) As measured by the Kessler 10 Scale. See Glossary.

(b) Indirect standardisation.

Relative socioeconomic disadvantage

The Socio-Economic Index for Area (SEIFA) compiled by the ABS includes attributes such as low income, low educational attainment, high unemployment and jobs in relatively unskilled occupations. The index refers to the area (the census collectors district) in which a person lives, it does not describe the socioeconomic situation of the particular individual.

Those people from the most disadvantaged socioeconomic areas (those in the lowest SEIFA quintile) were more likely to have a higher prevalence of mental and behavioural problems (12.3%) compared with 8.1% of people from the least disadvantaged socioeconomic areas (those in the highest SEIFA quintile). Both men and women living in the most disadvantaged areas had higher rates of mental and behavioural problems. Consistent with this, adults living in the most socioeconomically disadvantaged areas had a greater proportion of people with a very high level of psychological distress (7.0%) compared with those living in the least socioeconomically disadvantaged areas (2.1%). In 2001, for people living in the most socioeconomically disadvantaged areas, 6.5% of males and 7.5% of females had a very high level of psychological distress compared with 0.9% of males and 3.3% of females living in the least socioeconomically disadvantaged areas.

Very high level of psychological distress(a), By SEIFA(b)—Persons aged 18 years and over

CO-MORBIDITY: PHYSICAL CONDITIONS AND MENTAL AND BEHAVIOURAL PROBLEMS

National health priority area conditions

The seven national health priority area conditions are: Arthritis and musculoskeletal conditions, Asthma, Diabetes, Cancer, Cardiovascular conditions, Injuries, and Mental health conditions. Those with mental and behavioural problems had higher prevalence rates of Diseases of the musculoskeletal system and connective tissue (47.7% compared with 30.4%), Diseases of the circulatory system (21.2% compared with 16.4%), Asthma (17.0% compared with 11.0%) and Injury event in the last month (16.8% compared with 11.7%). The prevalence rates of Diabetes and Malignant neoplasms were similar for those with and without mental and behavioural problems.

Whether have mental and behavioural problems(a), By national health priority area conditions—All ages

With mental and behavioural problems

Without mental and behavioural problems

Total

%

%

%

Asthma

17.0

11.0

11.6

Diabetes

3.6

2.9

2.9

Diseases of the circulatory system

21.2

16.4

16.8

Diseases of the musculoskeletal system and connective tissue.

47.7

30.4

32.0

Had an injury event in the last month, action taken

16.8

11.7

12.2

Malignant neoplasms

1.6

1.4

1.4

(a) Mental and behavioural problems which have lasted or are expected to last for six months or more.

There were similar associations between the prevalence of a very high level of psychological distress and national health priority area conditions. Those people with Diabetes, Diseases of the circulatory system, Asthma, Malignant neoplasms, Injury event in the last month, and Mental and behavioural disorders, had significantly higher prevalence of a very high level of psychological distress than those people without these conditions. Of those people with mental and behavioural problems, 19.6% had a very high level of psychological distress compared with 1.7% of people without mental and behavioural problems.

Level of psychological distress(a), By national health priority area condition—Persons aged 18 years and over

Low (10-15)

Moderate (16-21)

High (22-29)

Very high (30-50)

Total

%

%

%

%

%

Asthma

54.1

25.8

13.7

6.4

100.0

Without asthma

65.6

22.7

8.5

3.2

100.0

Diabetes

60.5

20.6

12.4

6.4

100.0

Without diabetes

64.5

23.1

8.9

3.5

100.0

Diseases of circulatory system

63.7

21.2

10.3

4.8

100.0

Without diseases of circulatory system

64.5

23.5

8.7

3.3

100.0

Diseases of the musculoskeletal system & connective tissue

58.7

24.8

11.4

5.1

100.0

Without diseases of the musculoskeletal system & connective tissue

68.3

21.8

7.4

2.5

100.0

Had injury event, action taken

54.1

27.3

12.9

5.7

100.0

No injury event

65.5

22.5

8.6

3.3

100.0

Malignant neoplasms

59.3

19.4

15.0

6.3

100.0

Without malignant neoplasms

64.4

23.1

8.9

3.5

100.0

Mental and behavioural problems

20.8

29.5

30.1

19.6

100.0

Without mental and behavioural problems

69.4

22.3

6.6

1.7

100.0

(a) As measured by the Kessler 10 Scale. See Glossary.

When looking at the type of mental and behavioural problems by level of psychological distress, it is apparent that people with mental and behavioural problems, regardless of the type, had a significantly higher prevalence of high and a very high level of psychological distress than those people without mental and behavioural problems. Other research has also indicated that there is a strong association a between high score on the K10 and anxiety and affective disorders and a lesser but significant association between the K10 and other mental disorders categories (Andrews & Slade 2001).

Mental and behavioural problems(a), By level of psychological distress(b)—Persons aged 18 years and over

Low (10-15)

Moderate (16-21)

High (22-29)

Very high (30-50)

Total

%

%

%

%

%

Organic mental problems

*44.8

*23.7

**13.3

*18.3

100.0

Without organic mental problems

64.4

23.0

9.0

3.6

100.0

Alcohol and drug problems

26.4

23.5

24.6

25.5

100.0

Without alcohol and drug problems

64.7

23.0

8.9

3.4

100.0

Mood (affective) problems

11.6

27.7

35.6

25.0

100.0

Without mood (affective) problems

67.5

22.7

7.5

2.3

100.0

Anxiety related problems

16.9

28.5

31.5

23.1

100.0

Without anxiety related problems

67.0

22.7

7.8

2.5

100.0

Problems of psychological development

31.4

*14.2

24.8

29.6

100.0

Without problems of psychological development

64.6

23.1

8.9

3.4

100.0

Behavioural and emotional problems with usual onset in childhood/adolesence

*40.3

**15.6

*36.1

**8.0

*100.0

Without behavioural and emotional problems with usual onset in childhood/adolesence

64.4

23.0

9.0

3.6

100.0

Other mental and behavioural problems

38.6

33.1

*16.5

*11.9

100.0

Without other mental and behavioural problems

64.5

23.0

9.0

3.5

100.0

Symptoms and signs involving cognition, perceptions, emotional state and behaviour

15.1

22.3

19.6

43.1

100.0

Without symptoms and signs involving cognition, perceptions, emotional state and behaviour

64.9

23.0

8.9

3.2

100.0

Total Population

64.3

23.0

9.0

3.6

100.0

* estimate is subject to sampling variability too high for most practical purposes

** estimate has a relative standard error greater than 50% and is considered too unreliable for general use

(a) Mental and behavioural problems which have lasted or are expected to last for six months or more.

(b) As measured by the Kessler 10 Scale. See Glossary.

Selected physical conditions

In addition to the national health priority area conditions, many other long-term health conditions were more prevalent among those who have mental and behavioural problems than among those who do not. The most highly prevalent of these other conditions among those with mental and behavioural disorders were: bronchitis/emphysema, diseases of the female pelvic organs and genital tract, epilepsy, fluid retention, incontinence, migraine and stomach/duodenal/gastrointestinal ulcer. Those people with these physical conditions also had a significantly higher prevalence of a very high level of psychological distress.

Whether have mental and behavioural problems(a), By prevalence of selected physical conditions—All ages

With mental and behavioural problems

Without mental and behavioural problems

Total

%

%

%

Bronchitis/emphysema

7.2

3.1

3.5

Diseases of the female pelvic organs & genital tract

1.2

0.4

0.5

Epilepsy

1.5

0.5

0.6

Fluid retention (non-circulatory)

3.2

1.1

1.3

Incontinence: urine

2.6

0.8

1.0

Migraine

12.9

5.5

6.2

Stomach/duodenal/gastrointestinal ulcer

5.6

2.4

2.7

(a) Mental and behavioural problems which have lasted or are expected to last for six months or more.

Those people with physical conditions generally had a higher prevalence of a very high level of psychological distress. In addition to the physical conditions mentioned above, people with the following conditions also had high rates of a very high level of psychological distress: oedema (9.9%), benign neoplasms and neoplasms of uncertain nature (9.7%), rheumatoid arthritis (8.7%) and anaemia (8.7%).

Selected physical conditions, By level of psychological distress(a)—Persons aged 18 years and over

Low (10-15)

Moderate (16-21)

High (22-29)

Very high (30-50)

%

%

%

%

Bronchitis/emphysema

47.5

27.8

15.5

9.2

Without bronchitis/emphysema

65.0

22.8

8.8

3.4

Diseases of the female pelvic organs & genital tract

43.1

34.8

15.3

6.8

Without diseases of the female pelvic organs & genital tract

64.5

22.9

9.0

3.6

Epilepsy

55.9

24.2

11.7

8.2

Without epilepsy

64.4

23.0

9.0

3.6

Fluid retention (non-circulatory)

44.7

28.8

19.1

7.4

Without fluid retention (non-circulatory)

64.7

22.9

8.9

3.5

Incontinence: urine

51.6

23.6

13.8

11.1

Without incontinence: urine

64.5

23.0

9.0

3.5

Migraine

46.8

30.2

15.6

7.4

Without migraine

65.8

22.4

8.5

3.3

Stomach/duodenal/gastrointestinal ulcer

52.1

24.3

15.2

8.4

Without stomach/duodenal/gastrointestinal ulcer

64.8

23.0

8.8

3.4

Total population

64.3

23.0

9.0

3.6

(a) As measured by the Kessler 10 Scale. See Glossary.

HEALTH MODIFIABLE RISK FACTORS

Modifiable risk factors affect the onset, maintenance and prognosis of a variety of chronic diseases and their complications. Public health policy focuses risk factors which are avoidable or modifiable, and for which there is a potential health gain through early prevention or appropriate management. Certain modifiable risk factors have an association with mental and behavioural problems and other chronic conditions (AIHW 2001). This section covers information on four common behavioural risk factors: tobacco smoking, alcohol consumption, physical inactivity and body mass. People with mental and behavioural problems and those with a very high level of psychological distress have higher levels of some of the risk factors covered in this section and therefore may be at greater risk of other chronic diseases.

Tobacco smoking

Of those people with mental and behavioural problems, 32% reported being current daily smokers compared with 21.3% of those without mental and behavioural problems. Similarly, a smaller proportion of people with mental and behavioural problems reported that they had never smoked regularly (40.9%) compared with those without such problems (50.4%). The proportions of irregular smokers (who smoke less than once a day) and ex-smokers were similar for those with and without mental and behavioural problems.

Mental and behavioural problems(a), By smoker status—Persons aged 18 years and over

Similarly, those people with a very high level of psychological distress were more likely to be current daily smokers (38%) than were those with a low level of psychological distress (19%). Those people with a low level of psychological distress were more likely than those with a very high level of psychological distress to be ex-smokers (27% compared with 22%) or never smoked regularly (52% compared with 38%).

Alcohol consumption

Persons were classified to a health risk level (low risk, risky or high risk) based on their estimated average daily consumption of alcohol during the previous week. Those with mental and behavioural problems were more likely than those without such problems to be high risk drinkers (6.4% compared with 3.9%). Conversely, those without mental and behavioural problems were more likely to be low risk drinkers (51.6% compared with 44.4%). Of those with mental and behavioural problems, men were more likely than women to be high risk drinkers (9.3% of men compared with 4.4% of women). Those people with a very high level of psychological distress were also more likely than those with a low level of psychological distress to be high risk drinkers (7.3% compared with 3.8%).

Mental and behavioural problems(a), By alcohol risk—Persons aged 18 years and overLevel of psychological distress(a), By alcohol risk—Persons aged 18 years and over

Physical inactivity

In 2001, the level of exercise undertaken by those with and without mental and behavioural problems was similar. On the other hand, those people with a very high level of psychological distress were more likely than those with a low level of psychological distress to report being physically inactive (47% compared with 30%). Those with a low or moderate level of psychological distress were more likely to have reported exercising at some level (low, moderate and high levels) compared with those with a very high level of psychological distress.

Level of psychological distress(a), By exercise level—Persons aged 18 years and over

Body mass

Being overweight is a risk factor for many conditions such as heart disease, hypertension and diabetes, particularly when linked with other lifestyle factors such as lack of exercise. In the 2001 NHS, for people aged 15 years and over, self reported information on height and weight was collected and used to calculate their body mass index (see Explanatory Notes). This index was used to determine whether the person was in the normal range or the overweight range. For those people with mental and behavioural problems, 16% were in the overweight range (grade 2) compared with 13% of people without mental and behavioural problems. Those with and without mental and behavioural problems had a similar proportion of people in all the other body mass index (BMI) ranges. Of those people with a very high level of psychological distress, 2.6% were in the overweight range (grade 3) compared with 0.9% of people with a low level of psychological distress.

Combination of risk factors

Modifiable risk factors do not act independently. They tend to coexist and interact in their effects. Individual risk factors can be the contributory cause, rather than the sole cause, in a disease. All diseases including mental and behavioural problems are to some extent multi-factorial in their causes (AIHW 2001). Those people who have one risk factor are also likely to have other risk factors.

Those with mental and behavioural problems were more likely than those without such problems to have selected combinations of risk factors. Consistent with this, people with a very high level of psychological distress (compared with those with moderate or low level of psychological distress) tended to have a greater number of these risk factor combinations.

Health-related actions may include visiting doctors, other health professionals, hospital visits, taking medications or having days away from usual activities and other days of reduced activities. With the exception of the use of medication for mental health and wellbeing, the health actions reported in the 2001 NHS were not necessarily taken in relation to mental health. They could be taken for a number of reasons including mental and physical conditions as well as for usual medical check ups. Information about health-related actions was collected for the two weeks prior to interview.

General actions taken

Of those people with mental and behavioural problems, 63% took at least one health-related action in the two weeks prior to interview. In comparison, 41% of those without mental and behavioural problems took at least one health related action. Those with mental and behavioural problems showed higher rates of hospital visits (8% with and 5% without mental and behavioural problems), doctor consultations (39% with and 23% without), other health professional consultations (29% with and 17% without), days away from work or study (15% with and 8% without) and days of reduced activity (22% with and 10% without).

Actions taken for health(a), By whether have mental and behavioural problems(b)—All ages

With mental and behavioural problems

Without mental and behavioural problems

'000

%

'000

%

Hospital visit(c)

150.5

8.3

806.6

4.7

Consulted doctor(d)

699.4

38.6

3,931.8

23.0

Consulted other health professional(e)

529.5

29.2

2,929.3

17.1

Had days away from work or study

267.0

14.7

1,301.6

7.6

Had other days of reduced activity

403.7

22.3

1,646.8

9.6

Total people who did not take above action

674.8

37.2

10,182.3

59.5

Total people taking a health action(f)

1,137.8

62.8

6,921.4

40.5

Total

1,812.6

100.0

17,103.7

100.0

(a) Action taken in the two weeks prior to interview.

(b) Mental and behavioural problems which have lasted or are expected to last for six months or more.

(f) Persons may have reported more than one type of action and therefore components may not add to totals.

For people with mental and behavioural problems, the most common types of action were doctor consultations (39%) followed by consultations with other health professionals (29%). Women with mental and behavioural problems reported taking more health related actions than men with mental and behavioural problems (66% of women and 58% of men).

Similarly, people with a very high level of psychological distress (74%) took a greater proportion of health related actions than those with a low level of psychological distress (39%). The most common types of health actions taken by people with a very high level of distress included doctor consultations (53%), other health professional consultations (37%) and other days of reduced activity (34%).

People with mood (affective) problems, anxiety related problems, and symptoms and signs involving cognition and perceptions reported taking a higher proportion of health-related actions than people with other types of mental and behavioural problems. Those with mood (affective) problems and symptoms and signs involving cognition and perceptions, were more likely to report consulting doctors and other health professionals and reported a higher proportion of other days of reduced activities than those with other types of mental and behavioural problems. People who reported having organic mental problems were more likely to have been to the hospital in the last two weeks than those with any other type of mental and behavioural problems. Those people who reported having behavioural and emotional disorders reported a higher proportion of days away from work (20%) than those with any other mental and behavioural problems.

Number of visits to selected health professionals & admissions to hospitals

People with mental and behavioural problems reported consulting general practitioners, other health professionals and admissions to hospitals (three or more times in the last two weeks) at nearly two times the rate of those people without such problems. Similarly those people with a very high level of psychological distress, reported consulting general practitioners (three or more times in the last two weeks) at nine times the rate of those people with a low level of psychological distress. People with a very high level of psychological distress also reported consulting other health professionals and being admitted to hospital (three or more times in the last two weeks) at five to six times the rate of those people with a low level of psychological distress.

Number of consultations with selected health professionals and admissions to hosptials(a), By whether have mental and behavioural problems(b)—All ages

With mental and behavioural problems

Without mental and behavioural problems

Total

Number of visits/admissions

%

%

%

General practitioner

None

66.7

79.5

78.2

One

25.0

16.8

17.6

Two

6.6

3.0

3.4

Three or more

1.7

0.7

0.8

Total

100.0

100.0

100.0

Other health professional(c)

None

75.6

88.1

86.9

One

16.7

9.1

9.8

Two

5.9

1.9

2.3

Three or more

1.8

0.9

1.0

Total

100.0

100.0

100.0

Hospital

None

81.9

88.5

87.8

One

11.9

9.0

9.2

Two

4.2

1.7

2.0

Three or more

2.0

0.8

1.0

Total

100.0

100.0

100.0

(a) In the two weeks prior to interview.

(b) Mental and behavioural problems which have lasted or are expected to last for six months or more.

(c) Other health professionals. See Glossary.

Consultations with mental health professionals

In addition to a higher number of doctor consultations, those people with mental and behavioural problems were more likely to have seen a psychologist (2.9% with and 0.2% without mental and behavioural problems) and other mental health professional (4.3% with and 0.4% without) than were people without such problems. An estimated 46% of people with mental and behavioural problems did not have any contact with health professionals within the two weeks prior to interview compared with 65% of those without these problems.

Those with a very high level of psychological distress not only had a greater proportion of doctor consultations than those with a low level of psychological distress, they also had a greater proportion of consultations with psychologists (4.6% with a very high level of psychological distress and 0.2% with a low level of psychological distress) and other mental health professionals (7.0% very high and 0.2% low). Of those with a prevalence of a very high level of psychological distress, 33% did not consult a health professional compared with 66% of people with a low level of psychological distress.

Type of health professional contact was related to the type of mental and behavioural problem. Those people who reported having behavioural and emotional problems with usual onset in childhood/adolescence, were more likely to report seeing a psychologist (6.5%) than were those with other mental and behavioural problems. Of all the people with mental and behavioural problems, those people with mood (affective) and anxiety related problems had a higher proportion of contact with other health professionals in the two weeks prior to interview.

Consultations with health professionals(a), By types of mental and behavioural problems(b)—All ages

Hospital- isations

Doctors

Psych- ologists

Other mental health profes- sionals(c)

Other health profes- sionals(d)

No health profes- sional contact

Total

Type of mental and behavioural problem

'000

'000

'000

'000

'000

'000

'000

Organic mental problems

*15.2

*40.1

-

**2.6

*20.5

*48.7

100.0

Alcohol and drug problems

*9.6

41.0

*4.4

*7.9

24.4

46.0

100.0

Mood (affective) problems

10.0

43.0

3.9

5.3

26.7

40.7

100.0

Anxiety related problems

7.8

40.4

3.6

4.1

26.2

44.8

100.0

Problems of psychological development

*6.4

32.4

*2.3

*2.5

23.0

53.4

100.0

Behavioural and emotional problems with usual onset in childhood/adolescence

*6.6

35.8

*6.5

*7.3

19.3

48.1

100.0

Other mental and behavioural problems

*8.1

36.0

**1.4

*4.4

23.4

49.7

100.0

Symptoms and signs involving cognition, perceptions, emotional state and behaviour

13.6

48.3

*4.6

12.2

23.9

41.2

100.0

Total

8.3

38.6

2.9

4.3

24.6

46.3

100.0

* estimate has a relative standard error of 25% to 50% and should be used with caution

** estimate has a relative standard error greater than 50% and is considered too unreliable for general use

- nil or rounded to zero (including null cells)

(a) Health professional contact in the two weeks prior to interview.

(b) Mental and behavioural problems which have lasted or are expected to last for six months or more.

(c) Other mental health professionals. See Glossary.

(d) Other health professionals. See Glossary.

Medications taken for mental wellbeing

Medications for mental wellbeing can be used to manage some types of mental health conditions. Most experts recommend an approach that combines supportive psychotherapy, patient and family education, and medications. For some mental and behavioural problems, therapy or medication alone is enough to treat the condition (National Action Plan for Depression).

In 2001, an estimated 2.6 million people, representing 18% of the population had recently used one or more medications (including vitamins and natural remedies) for their mental wellbeing. A higher proportion of those with mental and behavioural problems (51%) than those without (14%) took some form of medication for their mental wellbeing. A higher proportion of people with mental and behavioural problems reported taking antidepressants (24.9% compared with 2.3% without mental and behavioural problems), tablets or capsules for anxiety and nerves (8.7% with and 1.1% without) and sleeping tablets or capsules (10.0% with and 3.4% without) than those without such problems. For people with mental and behavioural problems, the most common types of medication taken were antidepressants (reported by 25%) and vitamin or mineral supplements (reported by 18%). The highest use of medication was recorded for people who reported having symptoms or signs involving cognition and perceptions, organic mental problems, mood (affective) problems and people with alcohol and drug problems.

Medication use for mental wellbeing(a), By whether have mental and behavioural problems(b)—Persons aged 18 years and over

With mental and behavioural problems

Without mental and behavioural problems

Total

%

%

%

Sleeping tablets or capsules

10.0

3.4

4.1

Tablets or capsules for anxiety or nerves

8.7

1.1

1.9

Tranquillisers

3.3

0.4

0.7

Antidepressants

24.9

2.3

4.7

Mood stabilisers

2.6

0.3

0.6

Other medications for mental health

2.3

0.1

0.4

Total(c)

36.3

6.4

9.6

Vitamins or mineral supplements

17.5

6.7

7.8

Herbal or natural medications

13.7

4.5

5.4

Total(d)

50.5

14.3

18.1

Did not use medications

49.5

85.7

81.9

Total

100.0

100.0

100.0

(a) Used medications for mental wellbeing in the two weeks prior to interview. Type of medication is as reported by respondents.

(b) Mental and behavioural problems which have lasted or are expected to last for six months or more.

(c) All medications other than those identified by respondents as vitamin or mineral supplements, herbal or natural medications.

(d) Persons may have reported more than one type of medication and therefore components may not add to totals.

More than half the people with a very high level of psychological distress (54%) took some type of medication for their mental health and wellbeing compared with only 12% of people with low level of distress. People with a very high level of psychological distress reported taking a greater proportion of all types of medications for mental health and wellbeing than did people with low levels of psychological distress. For example, they reported taking a greater proportion of antidepressants (29% of people with a very high level of psychological distress compared with 2% of people with a low level of psychological distress), sleeping tablets or capsules (17% very high compared with 2% low) and tablets for anxiety or nerves (14% very high and 1% low).

Medication use for mental wellbeing(a), By level of psychological distress(b)—Persons and 18 years and over

Low (10-15)

Moderate (16-21)

High (22-29)

Very high (30-50)

Total

%

%

%

%

%

Sleeping tablets or capsules

2.4

4.8

8.9

16.9

4.1

Tablets or capsules for anxiety or nerves

0.7

2.3

5.1

13.6

1.9

Tranquillisers

0.2

0.8

1.7

5.6

0.7

Antidepressants

1.8

5.6

13.0

28.8

4.7

Mood stabillisers

0.3

0.5

1.4

4.1

0.6

Other medications for mental wellbeing

*0.1

*0.5

*0.7

*2.9

0.4

Total(c)

5.1

11.7

23.0

43.1

9.6

Vitamins or mineral supplements

5.4

10.4

15.8

15.4

7.8

Herbal or natural medications

3.6

7.8

10.5

10.5

5.4

Total(d)

11.7

23.0

36.8

53.7

18.1

Did not use medications

88.3

77.0

63.2

46.3

81.9

Total

100.0

100.0

100.0

100.0

100.0

* estimate is subject to sampling variability too high for most practical purposes

(a) Used medications for mental wellbeing in the two weeks prior to interview. Type of medication is as reported by respondents.

(b) As measured by the Kessler 10 Scale. See Glossary.

(c) All medications other than those identified by respondents as vitamin or mineral supplements, herbal or natural medications.

(d) Persons may have reported more than one type of medication and therefore components may not add to totals.

There was a greater proportion of people with mental and behavioural problems (6.8%) than those without (0.6%) that reported taking three or more medications for mental wellbeing. Of those with mental and behavioural problems, a greater proportion of people with organic mental problems reported taking three or more medications for their mental wellbeing (19%). Similarly, 11.3% of people with a very high level of psychological distress reported taking three or more medications for their mental wellbeing compared with 0.3% of people with a low level of psychological distress.

Number of medication types used for mental wellbeing(a), By mental and behavioural problems(b)—Persons aged 18 years and over

Most medication types except for sleeping tablets, vitamins or mineral supplements, and herbal or natural remedies were taken every day and/or night. Of the people who took medications for mental wellbeing, the majority of the medication types were taken for six months or more.

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